CLINICAL-SIGNIFICANCE OF REPEAT SEXTANT BIOPSIES IN PROSTATE-CANCER PATIENTS

Objectives. Six random systematic core biopsies (SRSCB) of the prostat e is considered by many to represent the standard method of detecting prostate cancer. We sought to evaluate the sensitivity of the transrec tal ultrasound (TRU)S-guided needle biopsies in 89 consecutive patient s with a history of biopsy-proven prostate cancer. These patients unde rwent repeat biopsy prior to enrollment in an ongoing, randomized prot ocol. We also compared the clinical and pathological features of patie nts with SRSCB-documented prostate carcinoma and negative repeat-sexta nt biopsy. Methods. Our study population consisted of 89 patients enro lled in our randomized, prospective study assessing the effect of andr ogen deprivation therapy in combination with radical prostatectomy for clinically localized prostate cancer. A comparison was made of the pa tients' rebiopsy results with initial biopsy. Patients having either a positive or negative rebiopsy were analyzed with respect to grade, T stage, prostate-specific antigen (PSA), PSA density (PSAD), organ-conf ined rate, and final surgical margin status. Results. Repeat sextant b iopsy was positive for prostate cancer in 71 (80%) patients and negati ve in 18 (20%) patients. There was no significant difference between p atients with a negative or positive rebiopsy with respect to PSA or PS AD. There was a trend toward greater prostate volumes in the negative- rebiopsy group (P = 0.08) and lower clinical stage in the negative reb iopsy (P = 0.025) group. In patients with a negative repeat biopsy, th e organ-confined (OC) rate was 77% (14/18 patients), as compared to th e positive-rebiopsy group of 56% (40/71 patients) (P = 0.08). Similarl y, the margin-positive rate in the negative-rebiopsy group was 17% (3/ 18 patients), as compared to the positive-rebiopsy group who had a mar gin-positive rate of 44% (51/71 patients) (P = 0.03). Conclusions. In patients with clinically localized disease, the sensitivity of SRSCB i n detecting carcinoma is 80%. The results of this study highlight the potential sampling error of the SRSCB and the implication of a negativ e rebiopsy in patients with clinically significant prostate cancer. (C ) 1997 by Elsevier Science Inc.